Minimum risk of intestinal parasitic infection to the visitors of Ghandruk, Kaski, Nepal: a pilot survey.

Ghandruk is one of the famous destinations of both international and domestic tourists situated in Kaski, Nepal. Travel-related diseases are an important aspect that one should consider before making a travel plan. Among diseases, zoonotically important ones make serious worries among visitors. In order to assess the existence of the zoonotically important parasitic disease in Ghandruk, a pilot survey was carried out by examining representative stool samples (n=51) of local residence, domestic animals, pet animals in Ghandruk. Samples were examined using direct smear as well as concentration methods. A questionnaire survey was conducted to see the associated risk factors among residents and their livestock of Ghandruk. None of the faecal samples from residents (n=14) found positive for any kind of intestinal parasites (IPs), while samples from most of the livestock: chicken (86%, 6/7), pigeons (75%, 3/4), cow (66%, 2/3), mule (60%, 3/5), and dog (60%, 3/5) showed heavy infection, except goat and buffalo indicated no infection. Eimeria spp., Ascardia spp. and cestodes spp. were the most prevalent IPs in livestock. Periodic deworming, walking outdoor with sandals/shoes, frequent use of soap and water for handwashing as reported by most of the residents (>80%) could be the main reason behind zero prevalence of IPs in them. The heavy infection among livestock may be incriminated to the contaminated vicinity and free-range livestock and poultry which were noticed in contact with river, sludge, and toilets during our field observation. Conclusively, it indicates that the residents of Ghandruk are conscious about their health, but have not paid satisfactory attention to the hygiene of their domestic animals including livestock, poultry and even pet. Though the observed parasites in livestock are of minimal zoonotic importance regarding safety of visitors, it is deemed necessary for at least to apply some preventive measures to mitigate the burden of parasites in their animals.

Recommendations for good practice for sedation in assisted conception.

Conscious sedation is a commonly used approach to provide pain relief during transvaginal oocyte retrieval. It has been shown to be effective with high levels of acceptability and patient satisfaction. Fundamental Standards and Development Standards in safe sedation practice have been set out by the Royal College of Anaesthetists and they recommend that Royal Colleges, in association with the relevant sub-specialty organizations, should develop guidelines on sedation methods appropriate to clinical practice in their sphere of influence. This Policy and Practice paper outlines the human resources and equipment necessary to optimize patients' safety for the administration of intravenous (I.V.) sedation in assisted conception units, based on the most current evidence and guidance available.

The effectiveness of foot reflexology in inducing ovulation: a sham-controlled randomized trial.

OBJECTIVE: To determine whether foot reflexology, a complementary therapy, has an effect greater than sham reflexology on induction of ovulation. DESIGN: Sham-controlled randomized trial with patients and statistician blinded. SETTING: Infertility clinic in Plymouth, United Kingdom. PATIENT(S): Forty-eight women attending the clinic with anovulation. INTERVENTION(S): Women were randomized to receive eight sessions of either genuine foot reflexology or sham reflexology with gentle massage over 10 weeks. MAIN OUTCOME MEASURE(S): The primary outcome was ovulation detected by serum progesterone level of >30 nmol/L during the study period. RESULT(S): Twenty-six patients were randomized to genuine reflexology and 22 to sham (one randomized patient was withdrawn). Patients remained blinded throughout the trial. The rate of ovulation during true reflexology was 11 out of 26 (42%), and during sham reflexology it was 10 out of 22 (46%). Pregnancy rates were 4 out of 26 in the true group and 2 out of 22 in the control group. Because of recruitment difficulties, the required sample size of 104 women was not achieved. CONCLUSION(S): Patient blinding of reflexology studies is feasible. Although this study was too small to reach a definitive conclusion on the specific effect of foot reflexology, the results suggest that any effect on ovulation would not be clinically relevant. Sham reflexology may have a beneficial general effect, which this study was not designed to detect.

Management of obese women in assisted conception units: a UK survey.

A national audit was performed to ascertain details of the management of clinically obese women at infertility clinics in the UK. This was with particular reference to body mass index (BMI) limits for specific treatments and general advice given to patients regarding obesity. A postal questionnaire was sent to all licensed assisted conception units (ACUs) in the UK offering fertility treatment. The return rate was 86 of 100 (86%). There was a great deal of variation between different units in the practice standards of obese infertile women. This audit demonstrates the wide variation in current UK practice and highlights the need for a broad discussion and adoption of national guidelines for the management of obese infertile women.

Intravenous sedation in assisted conception units: a UK survey.

A postal questionnaire was sent to all assisted conception units (ACUs) in the UK that undertake IVF. The return rate was 62 of 74 (84%). The majority of units (84%) used intravenous (i.v.) sedation for transvaginal egg collection, whereas 16% used general anaesthesia. There was a great deal of variation in personnel present during the procedure, the use of drugs, the degree of monitoring and the availability of emergency drugs. Most units titrate an i.v. benzodiazepine and i.v. opiate manually, usually midazolam and fentanyl, respectively. This audit demonstrates the wide variation in current UK practice and highlights the need for the adoption of national guidelines for safe use of i.v. sedation in ACUs.